Recommended Prenatal Medications During Pregnancy
Prenatal vitamins containing folic acid (400-800 mg), iron, and potassium iodide (150 mg) are the most important medications recommended for all pregnant women, ideally starting before conception and continuing throughout pregnancy. 1
Essential Prenatal Supplements
- Folic acid supplementation (400-800 mg daily) should be started before conception and continued throughout pregnancy to prevent neural tube defects and other congenital anomalies 1, 2
- Prenatal vitamins containing iron should be taken daily to prevent anemia during pregnancy 3, 4
- Potassium iodide (150 mg) supplementation is recommended to support proper fetal thyroid development 1, 3
- Women with higher risk for neural tube defects may require higher doses of folic acid (up to 4 mg daily) based on their risk factors 2
Medication Management During Pregnancy
Safe Medications During Pregnancy
- Acetaminophen is considered the safest analgesic for use during pregnancy when needed for pain or fever 5, 6
- Saline nasal sprays can be safely used for congestion throughout pregnancy 5
- Short-acting beta-agonists like albuterol can be used if needed for respiratory symptoms 5
- Certain antihistamines like chlorpheniramine are generally considered safe during pregnancy 6
- Most antacids are considered safe during pregnancy for heartburn and indigestion 6
Medications Compatible with Specific Conditions
- For pregnant women with rheumatic diseases, hydroxychloroquine, azathioprine, cyclosporine, tacrolimus, sulfasalazine, and colchicine can be continued throughout pregnancy 1
- When glucocorticoids are needed, prednisone and prednisolone should be tapered to ≤5 mg/day when possible to minimize maternal-fetal complications 1
- For short-term use of NSAIDs (if needed), they should be limited to the first and second trimesters, discontinued after 28 weeks gestation, and ibuprofen is preferred due to more safety data 1
Medications to Avoid During Pregnancy
- ACE inhibitors and angiotensin receptor blockers must be discontinued before conception due to risk of renal dysplasia, oligohydramnios, and other fetal complications 1, 7
- Methotrexate, mycophenolate, and cyclophosphamide are teratogenic and should be discontinued before pregnancy (methotrexate: 1-3 months; mycophenolate: 1.5 months; cyclophosphamide: 3 months before conception) 1
- Statins should be avoided during pregnancy 1
- Warfarin and other vitamin K antagonists should be avoided during pregnancy when possible due to risk of embryopathy 1
Special Considerations
- Women with diabetes planning pregnancy should receive preconception counseling and care from a multidisciplinary team including an endocrinologist, maternal-fetal medicine specialist, registered dietitian, and diabetes educator 1
- Women with preexisting diabetes should have comprehensive eye examinations before pregnancy or in the first trimester, with monitoring every trimester and for 1 year postpartum 1
- For women with toxoplasmosis infection during pregnancy, spiramycin (1g PO TID) may be prescribed through the FDA's Investigational New Drug process if there's no evidence of fetal infection 1
- For women with hypertension planning pregnancy, calcium channel blockers like nifedipine or methyldopa are safer alternatives to ACE inhibitors 7
Common Pitfalls to Avoid
- Excessive folic acid supplementation: 77% of pregnant women exceed the Tolerable Upper Intake Level for folate when combining diet and supplements 8
- Inadequate choline intake: Only 18% of pregnant women meet the Adequate Intake for choline, which is important for fetal brain development 8
- Continuing teratogenic medications: Many women don't receive proper preconception counseling about medication safety, leading to potential fetal exposure to harmful drugs 7
- Discontinuing necessary medications: Some women stop essential medications during pregnancy due to safety concerns, which may lead to worsening of maternal conditions that could negatively impact pregnancy outcomes 5
Preconception Care Recommendations
- All women of reproductive age should receive counseling about folic acid supplementation during routine medical visits, regardless of pregnancy plans 1, 2
- Women with chronic medical conditions should have medication reviews before conception to identify potentially harmful drugs 1
- Screening for sexually transmitted infections, thyroid disease, and recommended vaccinations should be completed before pregnancy when possible 1
- Lifestyle counseling regarding smoking cessation, alcohol abstinence, and avoiding recreational drugs should be provided 1